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Mild Traumatic Brain Injury, the US National Football League, and the Manufacture of Doubt: An Ethical, Legal, and Historical Analysis

This paper integrates legal, historical, and ethical approaches in analyzing the National Football League’s conduct regarding the risks its players face of experiencing concussions and the long-term neurodegenerative pathologies to which such injury is linked. Given that millions of children and adolescents play American football, and that the NFL concedes its behavior is a strong determinant of football culture, concussion issues are crucial matters of population health. Examining over 500 pages of testimony generated during Congressional hearings in 2009 and 2010, the paper links claims issued by leading NFL representatives to past efforts by industrial actors to manufacture doubt. The paper therefore argues that the history of public health is crucial to framing just public health policy in the present. The paper applies two frameworks drawn from public health ethics to argue first that a robust process of public reason is stymied by the NFL’s insistence on privately holding information relevant to its attitudes, practices and beliefs regarding concussions, and second, that the unequal distribution of "football prevalence" exposes already disadvantaged groups such as African-Americans to higher risks of concussions and neurological disease. The paper concludes that this latter possibility may contravene mandates of social justice, and, if so, would be ethically suboptimal.